The vital importance of utilization review

In the COVID-19 era, hospitals must preserve revenue integrity.


COVID-19 has altered the normal utilization patterns for hospitals across the country. Yet hospitals must still comply with the False Claims Act and must repay Medicare any overages within 60 days. And while many payers eased their preauthorization requirements for COVID-19, they will still issue denials of inpatient cases they deem inappropriate.

In this article, Kurt Hopfensperger, MD, JD, explains how a high-performing utilization review process with fully leveraged AI offers tremendous opportunity to help hospitals recover after the COVID-19 crisis.

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